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2997 Hwy 64E (2) .. . � . , _ , �,.: _ , . . .,_ , ,. .. _ . , , _.. _ . _ . . _ . . _... . _:. . � � �� r � ti • .. . . � e^ . P X �� ```� ` �'�fi , S�� DAVIE COUNTY HEALTH DEPARTMENT a �,��'� St IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION •NOTE:Issued in Compliance With Article II of G.S.Chapter 130a S nitary S�wage Systems Pe�mit NUmbe� Name__�� 1 .5��/i�/Ii!°i�t''c ��1��`/L-��Date ��S' N� 7 7 2 2 �7�.../� ��' Locatio _� .✓ `�'�Y N P� fcr� �/ ri' C� _ _ - —�g�}7 GC� flW y �� Subdivision Name Lot No. Se . or Block No. � Lot Size a �1��— _ House — Mobile Home ____ Business _� industry No. Bedrooms �v�—/g Na Baths _a.-_ No. in Family�__ PublicAssembly ' Other �Garbage Disposal YES ❑ NO ❑ Specifications for System: Auto Dish Washer YES p NO Q y � Auto Wash Ma^hine YES p NO [] . ' ��1 -��/°� Type Water Supply -- --- ----- ' ` 'This permit Void if sewage system described below is not installed within 5 years from date of issue: This permit is subject to revocation if site plans or the intended use change ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT �F RE INSTALLING THIS SYSTEM. " . Ne� ,�o�� ,, - 3� .� _ � ,-„e'"' �_ Im r v m n rmi � p o e , e t s p e t b y —��— •Contact a representative oi the Davie Counry Health Department for final inspection of this system between 8:30-9:30 A.M„ 1:00-1:30 P.M:�or 4:30-5:00 P.M.on day of completion.Telephone Number:704-634�986.$��,p -�� ` Final Instaltation Diagram: System Installed by _ � � � !/ � , / � �- 9`�. Certiticate of Completion � __ Date _ 'The signing of this certificate shall indicate that the system described above has been installed in compliance with ° the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfacrorily tor any given period of time. ;:_ r.0 _ v v • y �{ �. �; ., _ ;,� . ��.� . .� t , -:� r�, . s,� =-..., . •, :,� v V� _ �, -i't,.� • �j�� .r��T��Y",yr I. � �I��.,`��"` ,� '�"-��, - DAVIE COUNTY HEALTH ;DEPARTMENT 4��,�� , , �-. 1 IMPROVEMENTS PERMIT AND CERTIFICATE OF ,COMPLETION r 'NOTE Issued in.Compliance With Article II of G.S.Chapter 130a ' � .- Sanitary Sewage Systems Pe�rtlit Numbef -Name ;;� f;` .,,ar�,. ,r� c Ji1'.,Iif.ri' c =�``�'� /�"j/�,1'%i_ Date ��}f N� 7 9 2 2 ( .i� � � _ ��.._ ,� � Jr r.t�, � �� Locatio � �� / r' � / ,/r�! � � Y`ftrt9(t-'1��` /'n"(r,.�.. �..�.f, ,r_ C! � _ � . � � � Q J ,f , � � ' ' .�. �� _ - _ _�.�`1 G( fl(N J (�cl�; '4• . Subdivision Name � Lot No. Seq. or Block No. � r�� ,�, Lot Size �1'?L_—_._ House — Mobile Home ____ Bus ness _� Industry No. Bedrooms ��%�.No. Baths _�— No. in Family�__ Public Assembly Other � - Garbage Disposal YES p NO ❑ Specifications for System: °+� ,Auto Dish Washer YES p NO p V � Auto Wash Ma^hine YES p NO [� �G'��I ,/�� . :. 7YPe Water Supply �--- --------- 'This permit Void if sewage system described below is not instalJed within 5 years from date of issue. This permit is subject to revocation if site plans or the intended use change ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT�LAYOUT EF RE INSTAWNG THIS SYSTEM. .. �,�f� �o�a 4��..--� , , ;� 1..7 - � �,�F�� 1� Im rovements ermit b _L�r// — P P Y � ,, 'Contact a representative of the Davie Counry Health Department for final inspection of this system between 8:30-9:30 A.M., 1:00-1:30 P.M. or 4:30-5:00 P.M. on day of completion.Telephone Number: 704-634-�5986.�'?'(O � . . . � . r.. .. . . . . . / ___ '. \ :% ! Final Installation Diagram: System Installed by _�� %/��-1� 11 .. y,J i� ,' �� l� o. � �� ; ; .� Certificate of Completion � � L��__ Date /� ' _ ; 'The signing oi this certiticate shall indicate that the system described above has been installed in compliance witF� �' the standards set (orth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. .,�.,..,,� . �-�"'-� I . -` -,��'�, : DAVIE COUNTY HEALTH D�PARTMENT -�,X� C� ��` �� IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION - *NOTE: 'Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c �� •Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number Name ��- ��✓�l� •.� �'�„ �,. • ' � �� Date .�� r�•��:� N� �;�: �' ,,. -�i �� r�,�'�.-i. /f% .: �� ' .-��.... `� Location ..� � �/� � �. . , .--, >. _. _ ' � Subdivision Name l.ot No, Sec. or Block No. Lot Size._ �:.` � House Mobile Home _ Business _.�—'�� Speculation , . ,� . No. Bedrooms '��', �� No. Baths _�-� No. in Family -�r%�.�/� ,. :�s- Garbage Disposal YES � NO � Specifications for,SXsjem: ,�:� Auto Dish Washer YES ❑ NO ��^��,vT�,.�� ,,.,...:� � �- �`�' , Auto Wash Machine YES p NO /c:� / ,�� i.f•�'�� =��.��/,� �, Type Water Supply • -� ___ . 'This permit Void if sewage system described below is not installed within 36 months fro date of issue. , . �s�v 8�'�.� ._� �oo Pd � ' � , � � �, . o'� PM /�y cis � � �y • • _ ` .--.- ., � . � . `. . - " ,, 1" / . . .;:.. y�t1�. - .. ... . ^i(- (?'� '3'tti � \ � �'i� � . . . , � � �;.,��; � . :A �� , _ � 4;; 'r-c. ., ...... , ;4. ;:�:<;r�. . . � � �� F � � <�;� .. . . �, . ...:�. i Improvements permit by _..�� "Contact a representative of the Davie County Health Department for final inspection of this system between 8:30- � 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. � . � i .,•/ % �. �� / ! Final Installation Diagram: System Installed by�Y.��- �- •:�,•%��'�� I � i I � i , � i � �U�,� '� � ! . �� I � � I I � � - . � i , i 7,�i:L/ Certificate of Completion Date �J�� _ �, , � 'The signing of this certificate shall indicate that the system described above has been installed in compliance with th��t«.d d get f rt in the b v e lation, but shall in NO wa be taken as a u4r�nl�e that the s stem will function �,,-�;. ��.��,�'1��'��'��(;��: v � v �;^'�+ I �^ APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT 1!� �-�'-� *= C�;s n!-''i'', .. �c �� ir7:_. '• . ':� ;; � �,�'�'� d „ `� / Davie County Health Department � .�� I� Environmental Health Section ��7A�( � g �g95 . � ; P. O. Box 665 � � Mocksville, NC 27028 ' � � . 1. Application/Permit Requested By � S y. � r c �D w � �.,�\�, 1 � Mailing Address a��l 7 U S, ��w �/ G �( L , �1�10G�S�!��f, Home Pho ��Q�)2 �� g 4 7 '2 7b 2�' Business Phone �S<�) �i -�i�—��5�'7 ' 2. Name on Permit if Different than Above 3. Application for: ❑General Evaluation Septic Tank Installation Permit 4. System to Serve: ❑ House � Mobile Home � Place of Public Assembly usiness ❑ Industry ❑ Other ❑ Unknown 5. if house, mobile home: Subdivision Section Lot # p BasemenUPlumbing No. of People ❑ BasemenUNo Plumbing No. of Bedrooms - O Washing Machine No. of Bathrooms � Dishwasher Dwelling Dimensions � Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type �C�1^ ��^ ��e h �-e Saa�'� No. of People Served No. of Sinks y No. of Commodes � No. of Urinals � No. of Lavatories � No. of Water Coolers No. of Showers � Water Usage Figures 7. Type of water supply: Public � Private ❑ Community 8. Property Dimensions � � �Q- Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? es O No If yes, what rype? �'z 1� 'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: ��C1G� �� nn� ��d�' � � � � �� • � bc � � �� , This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges incurred from this application. , � - zG SS � � r DATE IGNATUR CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. I OWN the property. . I DO NOT OWN the property, If you checked Box#2, the rest of this form MUST be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized representative of the D vie Co nry.Health Department to enter upon above described property located in Davie County and owned by �e b� r�'�-�i ��c— to conduct all testing procedures as necessary to determine said site's swt ility for a ground absorption sewage treatment and disposal system. ,�� - 9,� DATE I NA RE DCHD�(7(93) Parcel#: J70000007903 Page 1 of 1 v ewft�` Davie County, NC - Basic Estate Search �ov��: Davie County Web Site Basic Search Real Estate Search Tax Bill Search Sales Search �Q dliew Prooertv Record for this Parcel Vtew Ma�for thi�Parcel View Tax Bill Information Parcel#:770000007903 Account#:82513238 Owne�Information Tax Codes HACH THI RY ADVLTAX-COUNTY T 997 US HIGHWAY 64 EAST READVLTAX-FIRE TAX OCKSVILLE NC 27028 Pro e Intormation Townshi nd(Units/Type): 0.690 AC FULTON ddress: 2997 E US HWY 64 Deed Information Local 2onin ate: 10/1999 Book: 00318 Page: 0040 Plat Book: Pa e: Le al Descri tion PIN .843 AC US HWY 64 5767999030 Pro e Values uitdin : 150 89 BXF• Land: 30 06 Market: 180 95 ssessed: 180 95 Deferred• Sales information No. Book Page Month Year Instrument Qual/UnQual Improved Price • 00191 0186 11 1996 WD Unqualified Vacant 0 00318 0040 10 1999 WD ualified Im roved 209 000 View Prooertv Record for this Parcel View Mao for this Parcel View Tax Bitl Informatfon r Return to Basic Search� All information on thfs site is prepared for the inventory of real property found within Davie County. All data (s compiled from recorded deeds, plats, and other public records and data. Users of this data are hereby notified that the aforementioned public information sources should be consulted for veriflcation of the information. All information contained herein was created for the Davie County's internal use. Davte County, its employees and agents make no warranty as to the correctness or accuracy of the information set forth on this site whether express or implied, in fact or in law, including without limitation the Implied warranties of inerchantability and fitness for a particular use. If you have any questions about the data displayed on this website ptease contact the Davie County Tax Office at(336) 753-6120. 1.5.9 - http://maps.daviecountync.gov/itsneWiew.aspx?prid=1461587 6/29/2016